Corporate Medical Director - Group Medicare Advantage

Humana Inc. Port Charlotte , FL 33948

Posted 2 weeks ago

Description

The Corporate Medical Director will provide insight and feedback to Group Medicare clients and leadership regarding claims experience, STARS scores, provider engagement, clinical programs, and other relevant information to inform suggested actions and improved outcomes.

Responsibilities

The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Required Qualifications

  • A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment

  • MD or DO degree

  • Board Certified in an approved ABMS Medical Specialty

  • Excellent communication skills

  • Strong presentation skills

  • Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products

  • Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab

Preferred Qualifications

  • Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.

  • Internal Medicine, Family Practice, Geriatrics, OBGYN, Hospitalist clinical specialists.

Scheduled Weekly Hours
40


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Corporate Medical Director - Group Medicare Advantage

Humana Inc.